Provider Demographics
NPI:1184287872
Name:REBECK, MORGAN TAYLOR (DDS)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:TAYLOR
Last Name:REBECK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 S WHIPPOORWILL ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-5070
Mailing Address - Country:US
Mailing Address - Phone:812-236-8551
Mailing Address - Fax:
Practice Address - Street 1:400 2ND ST S STE 250
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-1599
Practice Address - Country:US
Practice Address - Phone:715-808-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND145211223P0221X
WI1002582-151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry